Calcium Channel Blockers for Acute Traumatic Brain Injury

Overview

Journal Cochrane Database Syst Rev

Publisher Wiley

Specialties General Medicine
Health Services

Date 2000 May 5

PMID 10796727

Citations 4

Authors

J Langham

C Goldfrad

G Teasdale

D Shaw

K Rowan

Affiliations

Soon will be listed here.

Abstract

Background: Acute traumatic brain injury is a major cause of death and disability. Calcium channel blockers have been used in an attempt to prevent cerebral vasospasm after injury, maintain blood flow to the brain and so prevent further damage.

Objectives: To estimate the effects of calcium channel blockers in patients with acute traumatic brain injury and in a subgroup of brain injury patients with traumatic subarachnoid haemorrhage.

Search Strategy: Hand searching and electronic searching for randomized controlled trials available by October 1997.

Selection Criteria: Randomized controlled trials in patients with all levels of severity of clinically diagnosed acute traumatic brain injury.

Data Collection And Analysis: Two reviewers (JL and CG) independently assessed the identified studies for eligibility and extracted data from each study. Summary odds ratios were calculated using the Mantel-Haenszel method.

Main Results: Four RCTs were identified as eligible for inclusion in the systematic review. The effect of calcium channel blockers on the risk of death was reported in all RCTs. The pooled odds ratio for the four studies was 0.91 (95% confidence interval 0. 70 to 1.17). For the three RCTs that reported death and severe disability the pooled odds ratio was 0.85 (95% CI 0.68 to 1.07). In the two RCTs which reported the risk of death in a sub group of traumatic subarachnoid haemorrhage patients, the pooled odds ratio was 0.59 (95% CI 0.37 to 0.94). Three RCTs reported death and severe disability as an outcome in this subgroup, and the pooled odds ratio was 0.67 (95% CI 0.46 to 0.98).

Reviewer's Conclusions: This systematic review of randomized controlled trials of calcium channel blockers in acute traumatic head injury patients shows that considerable uncertainty remains over their effects. The effect of nimodipine in a subgroup of brain injury patients with subarachnoid haemorrhage shows a beneficial effect, though the increase in adverse reactions suffered by the intervention group may mean that the drug is harmful for some patients.

Citing Articles

Vasospasm in cerebral inflammation.

Eisenhut M Int J Inflam. 2015; 2014:509707.

PMID: 25610703 PMC: 4295158. DOI: 10.1155/2014/509707.

The occurrence of diffuse axonal injury in the brain: associated with the accumulation and clearance of myelin debris.

Wen L, Xu J, Zhan T, Wang H, Huang X, Liu W Neural Regen Res. 2015; 9(21):1902-6.

PMID: 25558240 PMC: 4281429. DOI: 10.4103/1673-5374.145358.

Cerebral vasospasm in traumatic brain injury.

Kramer D, Winer J, Pease B, Amar A, Mack W Neurol Res Int. 2013; 2013:415813.

PMID: 23862062 PMC: 3703898. DOI: 10.1155/2013/415813.

Antioxidant therapies for traumatic brain injury.

Hall E, Vaishnav R, Mustafa A Neurotherapeutics. 2010; 7(1):51-61.

PMID: 20129497 PMC: 2818465. DOI: 10.1016/j.nurt.2009.10.021.

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